Permit ` , ' " CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2009 -00342
{i + s Date Issued: 07/13/2009
` 13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171
TIGARD g Parcel: 1 S135BD00300
Jurisdiction: Tigard
Site address: 9735 SW SHADY LN 104
Subdivision: TIGARD MEDICAL MALL Lot: 0
Project: Tigard Medical Mall
Project Description: 3 branch circuits for H.V. /A.C. and G.F.I. receptacles
Owner: FEES
MCFADDEN, ARTHUR L Quantity Description Date Amount
BY ERIC SKLARZ, 621 SW MORRISON ST STE
#800 3 crt Branch Circuits 07/13/2009 $60.15
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/13/2009 $7.22
Electrical
Contractor:
R C COSTELLO ELECTRICAL CONTRACTING
INC
PO BOX 336
PHONE: 503 - 982 -7400
FAX: 503- 982 -7400
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $67.37
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained 'in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or 4 work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through A 5 -0100. You may obtain a copy of the rules or direct questions to DUNG by calling 503.246.6699 or 1.800.332.2344.
Y
Issued By: '"U A ---� in Permittee Signature: Cr L - - �--+
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Jul 12 2009 10:19AM HP LASERJET FAX — _ P.
y. — -
Electrical Permit Application RE C EI VED FOR OFFICE USE ONLY'
City of Tigard Daa_val L C * Permit No. LC, —n C13
II
• 13125 SW Hall Blvd ,Tigard, OR 97223 �I Plan Re ew
Phone: 503.639.4171 Fax. 503.598 196Q1 1 3 2 09 Date(gq: Other Permit
T t G R n Inspection Line 503.639.4175 Date Ready/By' luris Si See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD NotifiedMethod• Supplemental Information
' E OF ��a/I)I DIV!S$J ;:: fr ,:: r fi AI4 I,tWY;IEW `q` ' :`..r. ;,
❑ New construction Addition /alteration /replacernent
Please check all that apply (submit sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current - ❑ Marinas and boatyards.
CATEGORY or CONSTRU.00.111 i exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling I. IE Commercial /industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or
JOB STIE INFORMATION`. AND . LOCATION new motor load of 1 Y derived system.
❑ Emergency system. larger separate) vst
• "_, ❑ • Addition of e ❑ "A" "E" "I 2
10)HP or more. occupancy.
Job no.: lob site address: Gi 7 3 S S, bli S AA
❑ Six or more residential units. ❑Recreational vehicle parks
Clry'State ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 500 volts nominal
Suite /bldg. /apt. no.: / y Project name :'7 trn? 91 ❑ Seiviee or (eider 600 amps or more. -
FEE SCHEDULE
Cross street /directions to job site: Deaiiptioo 10'h. I Fa. I Taut L• '
' New residential single- or multi- family dwelling unit.
Includes attached garage. I
Subdivision: Lot no.: 1,000 sq. 1 or less 145.15 4
Ea add'/ 500 sq. ft. or portion 53.40 t
1 ax map /parcel no.: Limited energy, residential
.»ESCRIPTiON' OF W 1UC er , ty ' a( i
,,,, , i ! ,, (with above sq. f) 5. 2
, ( 1 /� /� f energy, multi- family
75.00 2
( � r
+ nt In C j u r r,c f S 'Ex r 1"1. Ii . / l residential (with above sq. ft.) _
/ '1 y r Services or feeders installation, alteration, and/or relocation
V, 7 , T re6pe 1 c it. ,s 200 amps or less 80.30 2
: ❑ PROPERTY OWNER : :
,. , [❑ : TENANT ", 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2 _
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454,65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 1 66.85 I _
Owner installation: This installation is being made on property that I own which is not 2W amps to 400 amps 1 100.30 2
intended for sale, lease. rent, or exchange. according to ORS 447, 449, 670. and 701. 401 amps to 599 amps 1 133.75 2
Branch circuits - new alteration, or extension, Per panel
Owner signature: Dale: A. Fee for branch circuits -4'rth
"[]. APPLICANT" ,CONTACT PERSON, :.
above service or feeder fee,
each branch circuit 6 2
Business name: B. Fee for branch circuits
Contact name:
without service or feeder fee i 46.85 1- /6,gs 2
first branch circuit _
Address: Each add'I branch circuit 7 6 65 t 1, , 2 2 a
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 1
90.90 2
dwelling, service and/or feeder
Phone:
( ) Fax: : ( ) Reconnect only I 66.85 2
E -mail: Pump or irrigation circle i 53.40 2
, -, CON1RAf TOR. _ , •, _ Sign or outline lighting 53.40 2
Business name: 1 I - t Signal cireuit(s) or limited -
- C . C bs fa +)o £ /ec+rl-ci 1 W✓14rr6�.04- , energy panel, alteration, or
Address: X 3
U
extension. Describe: ( Page 2 2
City/St aterZIP: n
i"IurUro. o !Z 9 r 7 OD 2_ Each additional inspection over allowable in any of the above I
Phone: (�^,`' Fax: p �7/ Per inspection 62.50
J.o) qg 2 - �0 U (S[) S) q6 z-` t `7 o f investigation per hour (t to min) 62 50
CCR Lic.: 37yp Z Electrical Lic.: 3 - 3Lfli Suprv. Lic.: 3g3q. s Industrial plant per hour 73 75
II �11,,
C , ELECTRICAL PERMIT. FEES
Suprv. Electrician st rl�tO I , required: 7„ . Ion 1 Its Subtotal: (pO, ) 5 -
d� Q" C �..-pS 'e � Date: )� lJ Plan review (25 °b of permit fee):
Print name:
t J W J J `} State surcharge (12% of permit fee): (- 22.
Authorized signature: '1'01'AL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date days after it has been accepted as complete.
• Number of inspections allowed per permit
1 \Permits\ELC- PermaAppdos 05/23,05 44O.4615T(ItiosicOMM'EB